Hearing Loss and the Voice

Abstract

The voice varies according to the context of speech and to the physical and psychological conditions of the human being, and there is always a normal standard for the vocal output. Hearing loss can impair voce production, causing social, educational, and speech limitations, with specific deviation of the communication related to speech and voice. Usually, the voice is not the main focus of the speech-language pathology therapy with individuals with hearing loss, but its deviations can represent such a negative impact on this population that it can interfere on speech intelligibility and crucially compromise the social integration of the individual. The literature vastly explores acoustic and perceptual characteristics of children and adults with hearing loss. Voice problems in individuals with this impairment are directly related to its type and severity, age, gender, and type of hearing device used. While individuals with mild and moderate hearing loss can only present problems with resonance, severely impaired individuals may lack intensity and frequency control, among other alterations. The commonly found vocal deviations include strain, breathiness, roughness, monotone, absence of rhythm, unpleasant quality, hoarseness, vocal fatigue, high pitch, reduced volume, loudness with excessive variation, unbalanced resonance, altered breathing pattern, brusque vocal attack, and imprecise articulation. These characteristics are justified by the incapability of the deaf to control their vocal performance due to the lack of auditory monitoring of their own voice, caused by the hearing loss. Hence, the development of an intelligible speech with a good quality of voice on the hearing impaired is a challenge, despite the sophisticated technological advances of hearing aids, cochlear implants and other implantable devices. The purpose of this chapter is therefore to present an extensive review of the literature and describe our experience regarding the evaluation, diagnosis, and treatment of voice disorders in individuals with hearing loss.

Analyses of Sustained Vowels in Down Syndrome (DS): A Case Study Using Spectrograms and Perturbation Data to Investigate Voice Quality in Four Adults With DS

“…Information regarding hearing ability would also be required to confirm the impact of hearing loss. HI is associated with hyperfunctional voice disorders in HI populations [56], as well as with pubophonic voice and diplophonia [55,56,57]. It is probable that HI contributed to M2's voice production in these tasks.…”

Perception of One’s Own Voice After Hearing-Aid Fitting for Naive Hearing-Aid Users and Hearing-Aid Refitting for Experienced Hearing-Aid Users

“…Compression, gain settings, and signal processing in hearing aids may alter the auditory feedback of one's own voice in such a way that they impede adequate control of vocal intensity (Dillon, 2012b;Laugesen et al, 2011;Stenfelt, 2011). Based on previous research (Coelho et al, 2015), it is likely that the decreased auditory feedback resulting from an unaided hearing impairment also poses a challenge for controlling vocal intensity appropriately.…”

“…While the study of Laugesen et al (2011) resulted in a new tool for assessing the own-voice experience for hearing-aid users, the implications were somewhat limited, as the authors surveyed only the hearing-aid users at one point in time. Previous studies have suggested that hearing impairment complicates vocal regulation and is a potential risk factor for physiological voice problems (Coelho et al, 2015), which adds another layer of complexity.…”

Frequency Characteristics in Children Using Cochlear Implant: A Comparison With Normal Hearing Peers

“…As a consequence of hearing impairment, speech and language skills tend to be either delayed or deviant depending upon several factors, such as type, degree, the onset of hearing loss, age at identification of deafness, and age at fitting appropriate amplification or implants. 4 - 6 Along with the deviancy, as mentioned earlier, due to lack of stimulation, the auditory feedback system loses the capability to regulate the voice characteristics. The vocal deviations that are prominently seen in individuals with hearing impairment include strain, breathiness, roughness, monotone, absence of rhythm, hoarseness, vocal fatigue, high pitch, reduced volume, and loudness with excessive variation; unbalanced resonance and imprecise articulation are essentially due to the lack of auditory monitoring of their own voice.…”